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After a seismic shift from in-person to virtual care in the spring of 2020, telehealth volumes have dropped from their peak and stabilized at a new version of normal, proving what healthcare providers in Northeast Ohio hypothesized from the early days of COVID-19: The use of telehealth will never return to pre-pandemic levels.
Virtual care has secured a place in healthcare access and delivery.
“And everybody’s trying to figure out what that place is,” said Dr. Vik Bhalla, chief medical officer of Summa Health Medical Group.
The role of telehealth in part will be determined by the decisions payers and regulators make in the coming months as temporary flexibilities they offered, which helped hospitals adapt to the skyrocketing need for virtual care, taper off and expire.
Given the dramatic growth in patient demand — and what is now a patient expectation — for telehealth, Northeast Ohio hospitals are preparing to continue offering virtual options and, in some cases, are looking to innovate with that technology.
The proliferation of telehealth in the past year-and-a-half, though it occurred under awful circumstances, has allowed healthcare providers an opportunity to explore new ways to better reach patients virtually, said Dr. Steven Shook, the Cleveland Clinic’s lead for virtual health.
“We’re just really excited to have had this opportunity to kind of stretch our wings here and try some different ways to connect with patients,” he said, adding that the system is continuing to listen to both patients and providers to see where else to take the technology to best serve patients.
Before March of 2020, telehealth was a small portion of the work at University Hospitals, with less than 11,000 virtual visits in 2019. Last year, the system recorded more than 417,000. And in the first six months of 2021, there were more than 176,000, indicating telehealth is here to stay, said Stacy Porter, UH’s vice president for Consumer Centric Strategy.
The Cleveland Clinic leapt from roughly 37,000 virtual visits in 2019 to 1.2 million in 2020. Though it is fully open for in-person care, the Clinic anticipates 20% of visits this year will be virtual.
Before the pandemic, Summa Health hadn’t used telehealth beyond a retail platform for acute care. It wasn’t part of the continuity of care or in use for primary care or specialty visits. After a rapid system-wide implementation of telehealth in the spring of 2020, roughly 60% of visits with Summa Health’s medical providers were virtual during the peak last year. Now, it’s closer to 5%, and Bhalla estimates that the norm will remain between 5% and 10% going forward.
Difficult to plan
Along with the public health emergencies declared at the federal and state levels came a lot of flexibilities around telehealth, which accommodated the skyrocketing use of virtual care. What those look like going forward will likely factor into how much healthcare organizations can focus on telehealth and virtual care, Bhalla said.
“This is all being debated from the federal government on down,” Bhalla said. “We don’t know where it’s going to land, and that really is going to be the driver of all of this.”
This summer, the State Medical Board of Ohio announced that it would be resuming in-person visit requirements on Sept. 17 — 90 days after Gov. Mike DeWine ended the state of emergency in Ohio — after suspending them in March 2020.
The federal public health emergency was extended in July for another 90-day period, but when it does end, the flexibility that supported the telehealth ramp-up ends with it. Payers and regulators are exploring ways to build a new framework around telehealth, but providers don’t have clarity on how those will take shape.
“It’s very difficult to plan a way forward that best serves our patients without knowing what the regulations are going to look like, what we’re going to be allowed to do and frankly what we’re going to be able to get reimbursed for,” Shook said. “So I think there’s a lot that’s still up in the air.”
Porter said the healthcare industry locally and nationally continues to gather stories and evidence to support the value, cost savings and improved health outcomes when digital health is part of a patient’s care path. She is hopeful that this evidence will motivate insurers to make decisions to keep permanent the flexibilities in some way, shape or form.
In April 2020, Albert Ferreira, MetroHealth’s director of telehealth operations, told Crain’s he believed a new standard of care had been realized with the explosion of telehealth use. At the time, he hoped that during the process stakeholders would grow to appreciate the value of telehealth and shed any misconceptions.
Now, Ferreira said that while not everyone is on board with telehealth and virtual care, progress has been made much further than before the pandemic, and faster than would have been possible had COVID-19 not forced folks toward virtual care.
“I think that what has come out of this is that we realize we have to kind of have a blend of both in-person as well as virtual patient care delivery of services,” he said.
Based on what he’s heard, Ferreira said he thinks the payer community and state and federal legislators are looking at telehealth with a “totally different perspective” than they did before the pandemic.
“They’re seeing that the value and the benefits are much greater than what people had anticipated prior to the pandemic,” he said. “And I think a lot of that is definitely attributed to the fact that we have a lot more data, and a lot more use cases to analyze and experiences that can provide us direct feedback on what maybe people believed before the pandemic.”
New uses, new ways to think
UH is committed to growing its digital health capabilities, not just in virtual visits but also in remote patient monitoring and other parts of the digital consumer experience, Porter said.
“How do we really get creative and more patient-friendly … in how we can care for patients who maybe need a higher level of care than just coming in for an outpatient appointment, but perhaps don’t need the level of care to be admitted to one of our facilities — and what do those options and those offerings look like?”
There are emerging use cases and new ways to think about care delivery that don’t exist today, Porter said. UH is looking at how to offer on-demand care virtually for patients who wish to seek care immediately, but for a need that wouldn’t be considered urgent, she said. The system is looking at how it can understand in real time its clinical capacity across the enterprise, recognizing that 10%-15% of its scheduled provider capacity goes unused every day as a result of late appointment cancellations or no-shows.
“We’re really excited about new opportunities to think about how we offer care,” Porter said.
Shook said the Clinic is looking at the growth of telehealth, but not just to grow its virtual health business for the sake of doing more virtual visits.
“What we want to do is improve patients’ outcomes,” he said, “and we want to be able to provide care at a lower cost, and we think virtual health can do both of those things.”
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